Just as the right medical treatment is critical to a patient's health, the right approach to selecting and adopting an electronic health records system is critical to the health, and even survival, of a physician's practice. And it's not just about the technology.
Big problems can come from making the wrong EHR choice for the wrong reasons, and from expecting a software vendor to successfully implement an EHR system without the engagement of the practice's physicians. Those problems will cost much more than the federal stimulus funds being offered to encourage physicians to implement EHRs.
For physician practices, EHR selection and adoption isn't a spectator sport: Doctors must be actively engaged. They must focus on evaluating features that support patient quality, safety, outcomes, privacy, and security. But they also must insist on features that improve the efficiency and viability of their practices.
We've been working with the independent physicians in our area as they choose EHR systems. In order to be successful, physicians must keep in mind the following three ideas:
1. Deployment isn't the same as utilization. Technology makes it possible, but the art is in making EHRs personal to physicians and their staffs. One size doesn't fit all, so it's important to find a system that operates the way physicians in a practice think and work.
2. Functionality isn't the same as usability. It isn't about the number of bells and whistles an application has. Think in terms of number of screens and mouse clicks required to qualify not just for federal "meaningful use" requirements, but also to deliver "meaningful value" to you and your patients. Evaluate whether functions are supportive and not disruptive during clinical decision-making, patient care, and treatment.
We're hosting a "vendor click-off" event so physicians can make side-by-side comparisons of how many mouse clicks it takes to perform key meaningful use criteria. ONC-ATCB certification shows only that an application can perform the required criteria, not how easily.
3. "Data" isn't the same as "information." Evaluate not only how the EHR captures information about care provided during a patient's treatment, but also how seamlessly the information is available and actionable during subsequent visits. Evaluate if it can securely and effortlessly receive and exchange information across national, regional, and local health information exchanges, in support of collaboration with physicians and caregivers in other settings.
Physician practices we've seen succeed with EHRs are those that focused on core functionality first. Here are five areas to concentrate on:
1. Patient registration. This includes staff entry and patient entry through patient portals and kiosks.
2. Scheduling. This isn't just for patients, but also for physicians, equipment, and resources.
3. Clinical documentation. This includes physician, nurse, and medical assistant documentation; testing and treatment order templates; decision support alerts for key conditions and treatment; and quality/outcome reporting.
4. Accounts receivable. Analyze charge capture, claim submission, and insurance payment postings; patient statement and payment postings; and management reporting.
5. Communication and care collaboration. Consider the ability to support the consult, referral, and care transition among caregivers; patient communication (secure e-mail, telephone calls, remote monitoring devices); tracking and handling of paper communication, such as mail and faxes; handling of medication history, formulary, eligibility, and electronic prescribing; electronic exchange of reports and results; and secure access to EHRs from handheld devices.
At Huntington Memorial Hospital, we're conducting seminars and providing educational resources, such as EHR selection toolkits. We're also offering an e-prescribing application that encourages physicians to take small steps into technology adoption, while providing them breathing room to evaluate and implement the right EHR systems for their practices.
In addition, we're building IT infrastructure that supports information sharing among multiple sources in a variety of formats, and puts information into a uniform structure so it can be shared with other electronic health records, personal health records, and decision support systems. Our goal is to make sure collaboration among inpatient, outpatient, and private practice settings occurs in what we refer to as "high definition"--in terms of detail, contrast, and refresh speed. That's needed to support fast, informed decision-making at the point of care, to improve the quality and lower the cost of care.
Hospitals have a license to house patients; physicians have a license to treat them. It's only by hospitals and physician practices working together, and adopting the right tools and processes, that we can meet the healthcare needs of our community.
Together with physicians in our community, we care for more than 11,000 people a day--10,000 of them in the private physicians' offices. We consider community physicians somewhere between a national treasure and a natural resource and want to make sure they don't become an endangered species. Creating a collaborative virtual health community that improves quality of care begins with physician engagement as much as it does adopting the right tools and processes. We hope with our encouragement and assistance that community physicians don't just survive, but thrive.
Rebecca Armato is executive director for physician and interoperability services at Huntington Hospital in southern California. Write to us at [email protected].